Micro-sequences of anger and shame and non-suicidal self-injury in youth: an ecological momentary assessment study.

OBJECTIVE: Non-suicidal self-injury (NSSI) is a significant mental health concern with the highest prevalence among adolescents. NSSI has been conceptualized as one of the maladaptive strategies to cope with challenging affect or a form of self-punishment. Although characterizing moment-to-moment associations between shame and NSSI in individuals' real-world environment and partitioning between- and within-person effects is critical for mobile and timely interventions, most studies examined habitual experiences of negative affective states and focused on adults. METHOD: In this study, we focused on in vivo anger at self and others and shame and NSSI among 158 adolescents 3 weeks following their psychiatric hospitalizations using ecological momentary assessment (EMA) technology. RESULTS: We found that greater between-person levels of anger at self and others were linked to a higher number of subsequent NSSI occurrences within a day. These findings remained primarily unchanged when we statistically adjusted for participants' age, sex assigned at birth, the number of current psychiatric diagnoses, EMA response rates, and youth lifetime history of SI. Within-person increases in NSSI were linked to increased anger at self over and beyond between-person average levels of NSSI. CONCLUSIONS: These findings highlight the potential regulatory role of NSSI to decrease negative affective states and point to the clinical utility of assessing and early mobile interventions targeting challenging affect in youth.

Daily Levels and Dynamic Metrics of Affective-Cognitive Constructs Associate With Suicidal Thoughts and Behaviours in Adults After Psychiatric Hospitalization.

The period after psychiatric hospitalization is an extraordinarily high-risk period for suicidal thoughts and behaviours (STBs). Affective-cognitive constructs (ACCs) are salient risk factors for STBs, and intensive longitudinal metrics of these constructs may improve personalized risk detection and intervention. However, limited research has examined how within-person daily levels and between-person dynamic metrics of ACCs relate to STBs after hospital discharge. Adult psychiatric inpatients (N = 95) completed a 65-day ecological momentary assessment protocol after discharge as part of a 6-month follow-up period. Using dynamic structural equation models, we examined both within-person daily levels and between-person dynamic metrics (intensity, variability and inertia) of positive and negative affect, rumination, distress intolerance and emotion dysregulation as risk factors for STBs. Within-person lower daily levels of positive affect and higher daily levels of negative affect, rumination, distress intolerance and emotion dysregulation were risk factors for next-day suicidal ideation (SI). Same-day within-person higher rumination and negative affect were also risk factors for same-day SI. At the between-person level, higher overall positive affect was protective against active SI and suicidal behaviour over the 6-month follow-up, while greater variability of rumination and distress intolerance increased risk for active SI, suicidal behaviour and suicide attempt. The present study provides the most comprehensive examination to date of intensive longitudinal metrics of ACCs as risk factors for STBs. Results support the continued use of intensive longitudinal methods to improve STB risk detection. Interventions focusing on rumination and distress intolerance may specifically help to prevent suicidal crises during critical transitions in care.

Attentional biases for sad faces in offspring of mothers with a history of major depression: trajectories of change from childhood to adolescence.

BACKGROUND: Theorists have proposed that the way children process social-emotional information may serve as a mechanism of risk for the intergenerational transmission of depression. There is growing evidence that infants and children of mothers with a history of major depressive disorder (MDD) during the child's life exhibit attentional avoidance of sad faces, which has been proposed as an early emerging emotion regulation strategy. In contrast, there is clear evidence that at-risk and depressed adolescents and adults exhibit difficulty disengaging attention from sad faces. METHODS: Seeking to link these two literatures, the current U.S.-based study used eye tracking within the context of an accelerated longitudinal design to assess attentional biases in 8-14-year-old offspring of mothers with a history MDD during the child's life (n = 123) or no history of MDD (n = 119) every six months for two years, allowing us to map trajectories of attention from age 8 to 16. RESULTS: Mother MDD history moderated age-based changes in children's gaze duration to sad (t[240] = 2.44, p = .02), but not happy (t[240] = 0.11, p = .91) or angry (t[240] = 0.67, p = .50), faces. Consistent our hypotheses, offspring of mothers with MDD exhibited significantly less attention to sad faces than offspring of never depressed mothers before age 8.5 but significantly more attention to sad faces after age 14.5, which was due to an increase in gaze duration to sad faces from childhood to adolescence among offspring of mothers with MDD (t[122] = 5.44, p < .001) but not among offspring of never depressed mothers (t[118] = 1.49, p = .14). CONCLUSIONS: It appears that the form, and perhaps function, of attentional bias may shift across development in at-risk youth. To the extent that this is true, it has significant implications not only for theories of the intergenerational transmission of depression risk but also for prevention and early intervention efforts designed to reduce this risk.

Preliminary evidence of contextual factors' influence on weight loss treatment outcomes: implications for future research.

BACKGROUND/OBJECTIVES: Behavioral health interventions, including behavioral obesity treatment, typically target psychosocial qualities of the individual (e.g., knowledge, self-efficacy) that are largely treated as persistent, over momentary contextual factors (e.g., affect, environmental conditions). The variance in treatment outcomes that can be attributable to these two sources is rarely quantified but may help inform future research and treatment development efforts. SUBJECTS/METHODS: The intraclass correlation coefficient (ICC) for weekly weight loss was calculated in three studies involving 10-12 weeks of behavioral obesity treatment delivered to adults via in-person group sessions, mobile application, or website. The ICC explains the proportion of variance between vs. within individuals, and was used to infer the contribution of individual vs. contextual factors to weekly weight loss. The analytic approach involved unconditional linear mixed effect models with a random effect for subject. RESULTS: The ICCs were very low, ranging from 0.01 to 0.06, suggesting that momentary contextual factors may influence obesity treatment outcomes to a substantial degree. CONCLUSIONS: This study yielded preliminary evidence that the influence of contextual factors in behavioral obesity treatment may be underappreciated. Future research is needed to simultaneously identify and quantify sources of within- and between-subjects variance to optimize treatment approaches.

Modeling reciprocal relations between emotion dysregulation and alcohol use using dynamic structural equation modeling: A micro-longitudinal study.

BACKGROUND: Research examining emotion dysregulation and alcohol use has increased exponentially over the past decade. However, these studies have been limited by their use of cross-sectional designs and narrow definitions of emotion dysregulation. To address these significant gaps in the extant literature, this study utilized state-of-the-art methodology (i.e., experience sampling) and statistics (i.e., dynamic structural equation modeling) to examine potential reciprocal associations between negative and positive emotion dysregulation and alcohol use at the momentary level. METHODS: Participants were 145 community women (mean age = 40.56, 40.3% white) experiencing intimate partner violence (IPV) and using substances. Surveys assessing negative and positive emotion dysregulation and alcohol use (i.e., number of standard drinks) were administered three times a day for 30 days using phone-based interactive voice recording. RESULTS: Significant contemporaneous effects indicated that negative and positive emotion dysregulation both co-occurred with alcohol use. However, levels of negative and positive emotion dysregulation did not predict later alcohol use, nor did alcohol use predict later levels of negative or positive emotion dysregulation. There was significant variability among participants in cross-lagged effects. CONCLUSIONS: Findings showed that negative and positive emotion dysregulation co-occurred with alcohol use and that there was significant interindividual variability in the cross-lagged associations between negative and positive emotion dysregulation and alcohol use. Research using idiographic approaches may identify women experiencing IPV for whom negative and positive emotion dysregulation drive alcohol use and alcohol use drives negative and positive emotion dysregulation.

Implementation and outcomes of home-based treatments for adolescents with anorexia nervosa: Study protocol for a pilot effectiveness-implementation trial.

OBJECTIVE: Although family-based treatment (FBT) is considered a first-line treatment for adolescent anorexia nervosa (AN), it is underutilized in community settings and is unavailable to many families for a multitude of practical reasons (e.g., costs of treatment, transportation constraints). Adapting FBT interventions for delivery in home-based and community-based settings may reduce pragmatic barriers to treatment uptake and engagement. METHODS: This pilot effectiveness-implementation trial will assess outcomes, implementation, and mechanisms of FBT adapted for the home setting (FBT-HB), delivered in the context of community-based behavioral health agencies. Adolescents with AN-spectrum disorders (n = 50) and their caregivers will be randomly assigned to either FBT-HB or home-based treatment as usual (TAU; integrated family therapy approach). Caregivers and adolescents will provide data on weight, eating, and putative treatment mechanisms, including caregiver self-efficacy and adolescent eating-related and weight-related distress. Implementation constructs of feasibility, acceptability, and appropriateness will be measured among providers and participating families. HYPOTHESES: We expect that FBT-HB will be feasible, acceptable, and appropriate, and will outperform TAU in terms of improvements in adolescent weight and eating-related psychopathology. We further expect that caregiver self-efficacy and adolescent eating-related and weight-related distress, but not general distress, will show greater improvements in FBT-HB relative to TAU and will be associated with better adolescent weight and eating outcomes in FBT-HB. POTENTIAL IMPLICATIONS: The proposed study has clear potential to advance scientific and clinical understanding of the real-world effectiveness of FBT for AN, including whether adapting it for the home setting improves its accessibility and effects on treatment outcome.

Interactions between Genetic, Prenatal, Cortisol, and Parenting Influences on Adolescent Substance Use and Frequency: A TRAILS Study.

INTRODUCTION: Dynamic relations between genetic, hormone, and pre- and postnatal environments are theorized as critically important for adolescent substance use but are rarely tested in multifactorial models. This study assessed the impact of interactions of genetic risk and cortisol reactivity with prenatal and parenting influences on both any and frequency of adolescent substance use. METHODS: Data are from the TRacking Adolescents' Individual Lives Survey (TRAILS), a prospective longitudinal, multi-rater study of 2,230 Dutch adolescents. Genetic risk was assessed via 3 substance-specific polygenic scores. Mothers retrospectively reported prenatal risk when adolescents were 11 years old. Adolescents rated their parents' warmth and hostility at age 11. Salivary cortisol reactivity was measured in response to a social stress task at age 16. Adolescents' self-reported cigarette, alcohol, and cannabis use frequency at age 16. RESULTS: A multivariate hurdle regression model showed that polygenic risk for smoking, alcohol, and cannabis predicted any use of each substance, respectively, but predicted more frequent use only for smoking. Blunted cortisol reactivity predicted any use and more frequent use for all 3 outcomes. There were 2 interactions: blunted cortisol reactivity exacerbated the association of polygenic risk with any smoking and the association of prenatal risk with any alcohol use. CONCLUSION: Polygenic risk seems of importance for early use but less so for frequency of use, whereas blunted cortisol reactivity was correlated with both. Blunted cortisol reactivity may also catalyze early risks for substance use, though to a limited degree. Gene-environment interactions play no role in the context of this multifactorial model.

Sex and age moderate the trajectory of guilt among children and adolescents with and without recent suicidal ideation.

We aimed to examine whether the trajectories of ecologically derived guilt differ among a transdiagnostic sample of youth with and without recent suicidal ideation and whether sex and age moderated this association. We assessed guilt 3 times a day over a 2-week period via ecological momentary assessment (EMA) technology in 102 children recruited from the community, outpatient, and inpatient settings. The average age of children was 10.95 y.o. (SD = 2.26, range 8-16) and the majority were male (54.9%) and White (76.5%). We found that the real-world guilt during a two-week EMA period was higher among youth with greater suicidal ideation severity in the past six months. Moreover, there was a significant moderating effect of sex and age on this association, such that the association between suicidal ideation severity and guilt was particularly strong among females compared to males and youth who were 10 years old or older. The findings were maintained when we adjusted for the relevant demographic and clinical characteristics, including age, minority status, parental income, EMA response rate, and current internalising symptoms. These preliminary findings highlight the clinical relevance of assessing and targeting feelings of guilt in the day-to-day lives of youth, particularly for females and older youth.

Single nucleotide polymorphism heritability and differential patterns of genetic overlap between inattention and four neurocognitive factors in youth.

Theoretical models of attention-deficit/hyperactivity disorder implicate neurocognitive dysfunction, yet neurocognitive functioning covers a range of abilities that may not all be linked with inattention. This study (a) investigated the single nucleotide polymorphism (SNP) heritability (h2SNP) of inattention and aspects of neurocognitive efficiency (memory, social cognition, executive function, and complex cognition) based on additive genome-wide effects; (b) examined if there were shared genetic effects among inattention and each aspect of neurocognitive efficiency; and (c) conducted an exploratory genome-wide association study to identify genetic regions associated with inattention. The sample included 3,563 participants of the Philadelphia Neurodevelopmental Cohort, a general population sample aged 8-21 years who completed the Penn Neurocognitive Battery. Data on inattention was obtained with the Kiddie Schedule of Affective Disorders (adapted). Genomic relatedness matrix restricted maximum likelihood was implemented in genome-wide complex trait analysis. Analyses revealed significant h2SNP for inattention (20%, SE = 0.08), social cognition (13%, SE = 0.08), memory (17%, SE = 0.08), executive function (25%, SE = 0.08), and complex cognition (24%, SE = 0.08). There was a positive genetic correlation (0.67, SE = 0.37) and a negative residual covariance (-0.23, SE = 0.06) between inattention and social cognition. No SNPs reached genome-wide significance for inattention. Results suggest specificity in genetic overlap among inattention and different aspects of neurocognitive efficiency.

Identifying behavioral types of dietary lapse from a mobile weight loss program: Preliminary investigation from a secondary data analysis.

Success in behavioral weight loss (BWL) programs depends on adherence to the recommended diet to reduce caloric intake. Dietary lapses (i.e., deviations from the BWL diet) occur frequently and can adversely affect weight loss outcomes. Research indicates that lapse behavior is heterogenous; there are many eating behaviors that could constitute a dietary lapse, but they are rarely studied as distinct contributors to weight outcomes. This secondary analysis aims to evaluate six behavioral lapse types during a 10-week mobile BWL program (eating a large portion, eating when not intended, eating an off-plan food, planned lapse, being unaware of caloric content, and endorsing multiple types of lapse). Associations between weekly behavioral lapse type frequency and weekly weight loss were investigated, and predictive contextual characteristics (psychological, behavioral, and environmental triggers for lapse) and individual difference (e.g., age, gender) factors were examined across lapse types. Participants (N = 121) with overweight/obesity (MBMI = 34.51; 84.3% female; 69.4% White) used a mobile BWL program for 10 weeks, self-weighed weekly using Bluetooth scales, completed daily ecological momentary assessment of lapse behavior and contextual characteristics, and completed a baseline demographics questionnaire. Linear mixed models revealed significant negative associations between unplanned lapses and percent weight loss. Unplanned lapses from eating a large portion, eating when not intended, and having multiple "types" were significantly negatively associated with weekly percent weight loss. A lasso regression showed that behavioral lapse types share many similar stable factors, with other factors being unique to specific lapse types. Results add to the prior literature on lapses and weight loss in BWL and provide preliminary evidence that behavioral lapse types could aid in understanding adherence behavior and developing precision medicine tools to improve dietary adherence.

Cannabis Use and Emotional Awareness Difficulties in Adolescents with Co-Occurring Substance Use and Psychiatric Disorders.

Background: Assessing predictors of cannabis use following adolescent substance use treatment may inform essential treatment elements to be emphasized before discharge. Adolescents with low emotional awareness may have limited resources for identifying and overcoming negative emotions, and therefore, use cannabis to regulate emotions. Purpose/objectives: The purpose of this study was to test the hypothesis that emotional awareness difficulties are associated with increased cannabis use across the transition out of substance use treatment. This hypothesis was investigated by applying an autoregressive random-intercept cross-lagged panel-modeling framework to test the fit of alternative models and inform hypotheses about directional associations between cannabis use and emotional awareness difficulties over time. Methods: Participants were 110 adolescents with co-occurring disorders and their families participating in an intensive home-based treatment trial. Adolescents reported on past 7-day cannabis use and difficulties in emotional awareness at baseline and three follow-up assessments across 12 months. Results: At baseline, 54% of the sample reported past-week cannabis use. A directional effect was supported such that difficulties with emotional awareness at 3 months' post-baseline, which corresponded to the approximate end of the treatment program, were associated with increased cannabis use at 6 months' post-baseline, controlling for the stability of cannabis use, and emotional awareness over time. Cannabis use, however, was not associated with subsequent difficulties in emotional awareness (i.e., effects in the opposite direction were not supported). Conclusions/Importance: Emotional awareness difficulties toward the end of a course of intensive outpatient treatment may be associated with increased cannabis use after the completion of treatment.

Developmental Pathways from Genetic, Prenatal, Parenting and Emotional/Behavioral Risk to Cortisol Reactivity and Adolescent Substance Use: A TRAILS Study.

Cortisol reactivity is a frequently studied biomarker of substance use, though infrequently examined in adolescence. However, past research provides evidence that multiple developmental influences, including genetics and both prenatal and postnatal environmental influences, contribute both to cortisol reactivity and adolescent substance use. The aim of this study was to assess the impact of these earlier developmental influences on cortisol reactivity to a social stress challenge and adolescent substance use (smoking, alcohol, and marijuana use frequency assessed at age 16 years), using data from the TRacking Adolescents' Individual Lives Survey (TRAILS; N= 2230 adolescents, 51% female). Developmental pathways included polygenic risk, prenatal stress, warm parenting (age 11), and internalizing and externalizing problems (intercepts and change from 11-16 years). Cortisol reactivity was associated with smoking but not alcohol or marijuana use. Externalizing problems were the stronger predictor of adolescent substance use, but internalizing problems also had an important role. Prenatal stress and middle childhood parenting operated via middle childhood externalizing problems, and parenting also operated via trajectories of growth of externalizing problems in predicting adolescent substance use outcomes. Further, there were protective effects of internalizing problems for alcohol and marijuana use in the context of a more comprehensive model. These developmental influences did not attenuate the association of cortisol reactivity and smoking. These findings suggest a need to understand the broader developmental context regarding the impact of internalizing pathways to substance use, and that it is unlikely that cortisol reactivity and smoking are associated solely because of common developmental influences.

Shared additive genetic variation for alcohol dependence among subjects of African and European ancestry.

Alcohol dependence (AD) affects individuals from all racial/ethnic groups, and previous research suggests that there is considerable variation in AD risk between and among various ancestrally defined groups in the United States. Although the reasons for these differences are likely due in part to contributions of complex sociocultural factors, limited research has attempted to examine whether similar genetic variation plays a role across ancestral groups. Using a pooled sample of individuals of African and European ancestry (AA/EA) obtained through data shared within the Database for Genotypes and Phenotypes, we estimated the extent to which additive genetic similarity for AD between AA and EAs using common single nucleotide polymorphisms overlapped across the two populations. AD was represented as a factor score by using Diagnostic and Statistical Manual dependence criteria, and genetic data were imputed by using the 1000 Genomes Reference Panel. Analyses revealed a significant single nucleotide polymorphism-based heritability of 17 percent (SE = 5) in EAs and 24 percent (SE = 15) in AAs. Further, a significant genetic correlation of 0.77 (SE = 0.46) suggests that the allelic architecture influencing the AD factor for EAs and AAs is largely similar across the two populations. Analyses indicated that investigating the genetic underpinnings of alcohol dependence in different ethnic groups may serve to highlight core etiological factors common to both groups and unique etiological factors specific to each ethnic group.

Effects of socioeconomic status and executive function on school readiness across levels of household chaos.

Isolating child attributes and familial characteristics that support school readiness in children on the upper half of the socioeconomic spectrum can complement existing research on lower-socioeconomic status (SES) children and facilitate a more complete understanding of how children's performance varies across the full SES spectrum. This study examined if relations between SES, two components of executive function (EF; set-shifting and inhibitory control), and school readiness vary as a function of household chaos in 564 four-year-old children, primarily from middle-to upper-middle class families in the Northeast Region of the United States. Structural equation modeling of direct and indirect effects revealed three major findings: 1) higher levels of EF were related to better school readiness regardless of level of household chaos; 2) SES had an indirect effect on school readiness through set-shifting; and 3) household chaos was negatively associated with school readiness.

Intervention Effects on Stage of Change Membership and Transitions among Adolescent Energy Balance Behaviors.

The transition from childhood to adolescence is a crucial period for the development of healthy behaviors to be sustained later in life. With obesity a leading public health problem, the promotion of healthy behaviors has the potential to make a huge impact. The current study evaluated Stage of Change progression in a large (N = 4158) computer-delivered, Transtheoretical Model-tailored intervention focusing on physical activity and fruit and vegetable consumption (FV). Markov models were used to explore stage transitions and patterns of discrete change from sixth to ninth grade. Nested model comparisons examined the consistency of these patterns across time and intervention condition. Major findings supported models in which participants were free to transition forward and backward to any of the stages, but higher probabilities were observed for remaining in the same stage or for transitioning one or two stages forward. Participants in the intervention group had higher probabilities of transitioning toward Maintenance, with more change occurring relative to the comparison group during transitions from grades six to eight but not for grades eight to nine.

Effects of Maternal Smoking during Pregnancy on Offspring Externalizing Problems: Contextual Effects in a Sample of Female Twins.

Studies of maternal smoking during pregnancy (MSDP) suggest increased risk for cognitive impairment and psychiatric outcomes. However, it is uncertain whether these associations are the direct result of MSDP or related to confounding familial variables associated with MSDP. The current study employed propensity score analysis to examine the effects of MSDP on offspring EXT using data from a large sample of 979 unrelated mothers. Logistic regression models were used to determine the propensity that the offspring of these mothers were likely to be exposed to MSDP [i.e., smoked during only the first trimester (MSDP-EARLY[E]) or smoked throughout their pregnancy (MSDP-THROUGHOUT[T])] given known familial confounders. Analyses focused on the effect of MSDP-E/T on the EXT behavior in offspring of these mothers (N = 1616) were conducted across the distribution of liability for MSDP-E/T and at different levels of risk for MSDP-E/T. MSDP-E/T was associated with offspring EXT problems, but the effects were partly confounded by the familial liability for MSDP. Further, the observed effects were not consistent across all levels of the MSDP risk distribution. These findings suggest a direct association between MSDP and offspring EXT behaviors, and that varied associations observed across studies may be the result of differences in the level of familial confounders that also have an effect on offspring EXT.

Evidence of Shared Genome-Wide Additive Genetic Effects on Interpersonal Trauma Exposure and Generalized Vulnerability to Drug Dependence in a Population of Substance Users.

Exposure to traumatic experiences is associated with an increased risk for drug dependence and poorer response to substance abuse treatment (Claus & Kindleberger, 2002; Jaycox, Ebener, Damesek, & Becker, 2004). Despite this evidence, the reasons for the observed associations of trauma and the general tendency to be dependent upon drugs of abuse remain unclear. Data (N = 2,596) from the Study of Addiction: Genetics and Environment were used to analyze (a) the degree to which commonly occurring single nucleotide polymorphisms (SNPs; minor allele frequency > 1%) in the human genome explains exposure to interpersonal traumatic experiences, and (b) the extent to which additive genetic effects on trauma are shared with additive genetic effects on drug dependence. Our results suggested moderate additive genetic influences on interpersonal trauma, h(2) SNP-Interpersonal = .47, 95% confidence interval (CI) [.10, .85], that are partially shared with additive genetic effects on generalized vulnerability to drug dependence, h(2) SNP-DD = .36, 95% CI [.11, .61]; rG-SNP = .49, 95% CI [.02, .96]. Although the design/technique does not exclude the possibility that substance abuse causally increases risk for traumatic experiences (or vice versa), these findings raise the possibility that commonly occurring SNPs influence both the general tendency towards drug dependence and interpersonal trauma.

Your Path to Transplant: a randomized controlled trial of a tailored computer education intervention to increase living donor kidney transplant.

BACKGROUND: Because of the deceased donor organ shortage, more kidney patients are considering whether to receive kidneys from family and friends, a process called living donor kidney transplantation (LDKT). Although Blacks and Hispanics are 3.4 and 1.5 times more likely, respectively, to develop end stage renal disease (ESRD) than Whites, they are less likely to receive LDKTs. To address this disparity, a new randomized controlled trial (RCT) will assess whether Black, Hispanic, and White transplant patients' knowledge, readiness to pursue LDKT, and receipt of LDKTs can be increased when they participate in the Your Path to Transplant (YPT) computer-tailored intervention. METHODS/DESIGN: Nine hundred Black, Hispanic, and White ESRD patients presenting for transplant evaluation at University of California, Los Angeles Kidney and Pancreas Transplant Program (UCLA-KPTP) will be randomly assigned to one of two education conditions, YPT or Usual Care Control Education (UC). As they undergo transplant evaluation, patients in the YPT condition will receive individually-tailored telephonic coaching sessions, feedback reports, video and print transplant education resources, and assistance with reducing any known socioeconomic barriers to LDKT. Patients receiving UC will only receive transplant education provided by UCLA-KPTP. Changes in transplant knowledge, readiness, pros and cons, and self-efficacy to pursue LDKT will be assessed prior to presenting at the transplant center (baseline), during transplant evaluation, and 4- and 8-months post-baseline, while completion of transplant evaluation and receipt of LDKTs will be assessed at 18-months post-baseline. The RCT will determine, compared to UC, whether Black, Hispanic, and White patients receiving YPT increase in their readiness to pursue LDKT and transplant knowledge, and become more likely to complete transplant medical evaluation and pursue LDKT. It will also examine how known patient, family, and healthcare system barriers to LDKT act alone and in combination with YPT to affect patients' transplant decision-making and behavior. Statistical analyses will be performed under an intent-to-treat approach. DISCUSSION: At the conclusion of the study, we will have assessed the effectiveness of an innovative and cost-effective YPT intervention that could be utilized to tailor LDKT discussion and education based on the needs of individual patients of different races in many healthcare settings. TRIAL REGISTRATION: ClinicalTrials.gov, number NCT02181114.

Same-Day and Next-Day Associations Between Relational Factors and Intimate Partner Violence in Young Adult Couples.

Objective: The prevalence of intimate partner violence (IPV) is high, with young adults at increased risk. IPV is largely understood as a dyadic process, as it involves both partners and is inherently influenced by the behaviors of both partners. The objective of this study was to examine the proximal influence of relationship satisfaction and conflict on same-day and nextday IPV perpetration among young adult couples. Method: This study used data from young adult couples (N = 172) who completed a 60-day daily-diary design. The Actor Partner Interdependence Model was used to examine whether within- and between-person levels of relationship satisfaction and conflict were associated with same-day and next-day IPV perpetration. Results: Results suggest that high levels of one's own and one's partner's relationship satisfaction was associated with low levels of same-day and next-day psychological IPV. For women, but not men, high levels in their own and their partner's relationship satisfaction were associated with low levels in same-day physical IPV perpetration. Conversely, high levels in one's own and their partner's conflict was associated with high levels of same-day psychological IPV perpetration. For women, but not men, high levels in their partner's conflict were associated with high levels of same-day physical IPV perpetration. Conclusion: Results suggest that relationship dissatisfaction and conflict may be proximal risk factors for IPV perpetration, particularly psychological IPV perpetration, implying these factors may be effective targets for prevention and intervention.

Measuring emotion dysregulation in daily life: an experience sampling study.

BACKGROUND: Literature underscores the importance of emotion dysregulation in clinical research. However, one critical limitation of the existing investigations in this area involves the lack of psychometrically valid measures for assessing emotion dysregulation in individuals' daily lives. This study examined the factor structure and psychometric properties of momentary versions of the Difficulties in Emotion Regulation Scale (mDERS) and the Difficulties in Emotion Regulation Scale-Positive (mDERS-P). METHODS: Participants were 145 community women (M age = 40.66, 40.7% white) experiencing intimate partner violence and using substances who participated in a baseline interview and then completed surveys three times a day for 30 days. RESULTS: Analyses supported the reliability of the mDERS and the mDERS-P. The two-state, two-trait model, with separate factors for negative and positive emotion dysregulation at both the within-and between-levels, fit the data best. Momentary negative, but not positive, emotions were positively related to the mDERS; both momentary negative and positive emotions were positively related to the mDERS-P. Baseline trait negative, but not positive, emotion dysregulation, was related to greater variability in momentary negative and positive emotion dysregulation. CONCLUSION: Findings advance our understanding and measurement of emotion dysregulation using intensive longitudinal approaches.